The overall objective is to enhance the quality of care available in the Western United States for women with trophoblastic disease (TD) by means of an outreach program and to conduct research directed toward improved diagnosis and treatment of TD. The goals for the current year are: 1) continue to upgrade the outreach program; 2) continue evaluating pulse actinomycin D in good risk TD patients; 3) assess the effect of oral contraceptives on the incidence of past molar trophoblastic disease in our clinic; 4) compare methotrexate to actinomycin D (ACT-D) as pre-emptive treatment of high risk (for TD) molar pregnancy; and 5) continue investigating SP-1 and other placental marker proteins for their potential use in TD.